Risk Factors for Missed Follow-up Appointments among Facial Trauma Patients.

OBJECTIVE: A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors. METHODS: Follow-up appointments for facial trauma over a three-month period at a single, safety-net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed. RESULTS: A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38 - 3.54]), afternoon visits compared to morning (OR 3.14 [1.94 - 5.07]), lack of private health insurance (OR 2.91 [1.68 - 5.18]), and presence of midface fractures (OR 2.04 [1.28 - 3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35 - 0.89]), surgical management (OR 0.48 [0.30 - 0.77]), and the presence of non-removable hardware (OR 0.39 [0.23 - 0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12 - 3.4]), lack of private health insurance (aOR 2.73 [1.55 - 4.8]), and midface fractures (aOR: 2.09 [1.21 - 3.59]). CONCLUSION: Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.

Zinc toxicity: denture adhesives, bone marrow failure and polyneuropathy.

A 36-year-old female developed bone marrow failure diagnosed as myelodysplastic syndrome (MDS) (Sidebar), followed shortly by a peripheral neuropathy and a gait disturbance. While waiting for a bone marrow transplant, she reported to us that she had seen attorney-generated, televised advertisements concerning the role of denture adhesives relating to her malady. Labs were then obtained demonstrating she had dramatic and unsuspected hypocupremia and hyperzincemia. Administration of copper and cessation of denture adhesives resulted in recovery of her hematopoietic system and partial resolution of the neurological sequela.